LMP301 Lecture 12: Diabetes Flashcards
Diabetes (68 cards)
1
Q
Diabetes is a(n) ___ disorder
A
endocrine
2
Q
Effects of insulin binding to receptor
A
- Translocation of GLUT-4 to membrane
- Glycogen synthesis
- Glycolysis
- FA synthesis
3
Q
Glucose -> glycogen through what process?
A
oxidation
4
Q
In the fed state, liver removes ___% of glucose load
A
70
5
Q
Excess glucose is…
A
- converted to VLDL
- stored in adipose tissue
6
Q
What happens in the fasting state?
A
- glycogen breakdown
- gluconeogenesis
7
Q
In gluconeogenesis, what are the starting materials?
A
- glycerol
- lactate
- pyruvate
- AA
8
Q
What can increase blood glucose?
A
- glucagon
- GH
- Adrenaline
- Cortisol
9
Q
GH is made in the…
A
a. pituitary
10
Q
Cortisol is made in the…
A
adrenal gland
11
Q
Synthesis / cleaving of insulin
A
pre-proinsulin -> proinsulin -> insulin
12
Q
Composition of insulin
A
2 AA chains connected by disulfide links
13
Q
Insulin inhibits…
A
- lipid ketosis
- somatostatin
- glucagon
14
Q
Insulin promotes…
A
- glucose uptake
- K+ and PO4^3- uptake
- synthesis of protein
15
Q
Besides gestational, type I, and type II diabetes, what other causes might there be?
A
- genetic diseases cause defective B-cell
- genetic diseases infect pancreas / other endocrine organs
e.g. hematochromatosis, Cushings’, pheochromocytoma
16
Q
Complications of DM
A
- microangiopathy
- retinopathy
- nephropathy
- neuropathy
- macroangiopathy
17
Q
microangiopathy
A
small vessels being destroyed due to high level of glucose
18
Q
neuropathy
A
damage to PNS
19
Q
macroangiopathy
A
Diseases in large vessels due to high blood glucose
20
Q
Diagnosis for DM.
What is used to confirm diabetes?
A
FBG >= 7
PG >= 11.1
OGTT >= 11.1
FBG or OGTT must surpass limit (just one)
21
Q
FPG
A
fasting plasma glucose
22
Q
PG
A
random plasma glucose
23
Q
If testing for PG, what must be noted?
A
PG >= 11.1, but they must also display symptoms of
- Polydipsia
- Polyuria
- Weight loss
24
Q
OGTT
A
oral glucose tolerance test
- give 75 g of glucose and measure PG 2h later
- repeat on different day
- only use when absolutely have to (ambiguous case)
25
What are the grey zones of diabetes?
- IFG
- IGT
- IFG and IGT
26
IFG
impaired fasting glucose
| - FPG is higher than normal, but >= 7
27
IGT
impaired glucose tolerance
- normal FPG
- OGTT is higher than normal, but not >=11.1
28
People (at risk for) diabetes should be screened for...
- heart disease
- hypertension
- dslipidemia
29
3 ways to monitor DM
1. self-monitor of blood glucose / point-of-care testing
2. microalbuminuria
3. monitor mean glycemia
30
What is used for self-monitor of blood glucose?
personal glucometers, which need whole blood sample
31
microalbuminuria is an indicator of...
Nephropathy
32
microalbuminuria
small amount of albumin found in the urine
33
_____ = mean glycemia over long term
glycated hemoglobin (HbA_1c)
34
What is an advantage of monitoring mean glycemia
See how patient has behaved over the past 3 months
35
Many proteins become ___ due to hyperglycemia
glycated
36
Structure of HbA_1c
glucose attached (non-enzymatically) to valine (at N term of HbA)
37
HbA1c has the ___ concentration & lifespan as RBC, which is...
same
| 120 days
38
HbA1c should be monitored every...
3 months
39
Treatment target for HbA1c
=< 0.07
40
Treatment target for mean plasma glucose
=< 9.5
41
What parmacological management of diabetes is there?
antihyperglycemic agents can be used
42
antihyperglycemic agents can be used to...
- increase insulin sensitivity
- increase insulin secretion
- slow rate of carb absorption
43
which drug: increase insulin sensitivity
metformin
44
which drug: increase insulin secretion
sulfonylureas
45
which drug: slow rate of carb absorption
a-glucosidase
46
Insulin should be used to treat diabetes when...
no other options work
| Usually given as insulin + another drug (do not want to be solely dependent on insulin)
47
Complications of diabetes
1. Diabetic ketoacidosis
2. Hyperosomolar non-ketotic coma
3. hypoglycemia
48
symptoms of diabetic ketoacidosis
- dehydration
- vomiting
- hyperventilation
49
Why do some diabetics experience ketoacidosis?
Can't use glucose, so use fat (ketones) as fuel for brain
50
What hormones tend to be secreted in response to diabetic stress?
- catecholamines
- cortisol
- GH
(all agonist to insulin)
51
Why do some diabetics experience dehydration?
1. ketoacidosis causes vomiting
| 2. hyperglycemia causes glucosuria & osmotic diuresis
52
How to manage diabetic ketoacidosis?
- ASAP: give insulin and fluids
- Give K+ to balance out effects of insulin
- bicarb: neutralize acidosis
53
Effect of insulin on K+
Insulin makes cells take up K+
54
Who gets diabetic ketoacidosis?
type I
55
Who gets hyperosmolar non-ketotic coma?
type I
56
symptoms of hyperosmolar non-ketotic coma
- hyperglycemia
- osmotic diuresis / glucosuria
- dehydration
- unconscious
57
hyperosmolar non-ketotic coma is a ___ disorder
chronic (develops over time)
58
diabetic ketoacidosis is an ____ disorder
acute (happens very rapidly)
59
why do people with hyperosmolar non-ketotic coma not have ketosis symptoms, but have hyperglycemia?
Residual insulin in body can prevent ketoacidosis symptoms, but not enough to prevent hyperglycemia
60
Treatment of hyperosmolar non-ketotic coma
Show rehydration and insulin
61
Of the 3 complications of diabetes, which is the most severe?
hypoglycemia is a clinical emergency
62
symptoms of hypoglycemia
- sweating
- shaking
- tachycardia
- weak
- nausea
- confusion
- coma
63
biochemical diagnosis of hypoglycemia
<2.2
64
Treatment of hypoglycemia
give glucose
65
causes of hypoglycemia for diabetics
- excess insulin
- not enough carb intake
- exercise
66
Risk factors for developing diabetes
- hypertension
- dyslipidemia / overweight / abdominal obesity
- other diseases (schizophrenia, PCOS, vascular)
- family history
- IGT or IFG
- gestational DM or macrosomic infant
- ethnicity
- metabolic syndrome
67
Which ethnic groups are at higher risk for diabetes?
- aboriginals
- hispanics
- asians
- s. asians
- africans
68
Metabolic syndrome: 3 of the following must be met...
- waist circumference
- TG
- HDL
- BP
- FBG
